No abstract

BACKGROUND: Men with locally (LAPCa) or regionally advanced (RAPCa) prostate cancer are at high risk of death from their disease. Clinical guidelines support multi-modal approaches, which include radical prostatectomy (RP) followed by radiotherapy (XRT) or radiotherapy plus androgen deprivation therapy (ADT). However, limited data exists comparing these substantially different treatment approaches. Using SEER-Medicare data, we compare survival outcomes and adverse effects associated with RP+XRT vs XRT+ADT in these men. METHODS: SEER-Medicare data was queried for men with cT3-T4, N0, M0 (LAPCa) or cT3-T4, N1, M0 (RAPCa) prostate cancer. Propensity score methods were used to balance cohort characteristics between treatment arms. Survival analyses were analyzed using the Kaplan-Meier method and Cox proportional hazards models. RESULTS: From 1992 to 2009, 13,856 men (≥65 years) were diagnosed with LAPCa or RAPCa, of which 6.1% received RP+XRT vs 23.6% who received XRT+ADT. At a median follow-up of 14.6 years, there were 2189 deaths in the cohort, of which 702 were secondary to prostate cancer. Irrespective of tumor stage and Gleason score, adjusted 10-year prostate cancer-specific survival and 10-year overall survival favored men who underwent RP+XRT when compared to XRT+ADT. However, RP+XRT vs. XRT+ADT was associated with higher rates of erectile dysfunction (28% vs. 20%, p=0.0212, respectively) and urinary incontinence (49% vs. 19%, p<0.001, respectively). CONCLUSIONS: Men with LAPCa or RAPCa treated initially with RP+XRT had a lower risk of prostate cancer-specific death and improved overall survival when compared to those men treated with XRT+ADT, but experienced higher rates of erectile dysfunction and urinary incontinence.

At present, eszopiclone and zolpidem are the most commonly prescribed drugs for treating insomnia. Despite the established relationship between sleep disturbance and anxiety, it remains unknown whether targeted treatment for insomnia may affect acute anxiety. Therefore, the objective of this study was to examine the effects of three different doses (1, 3, and 10 mg/kg) of eszopiclone and zolpidem on the states of sleep and wakefulness, levels of anxiety-like behavior, and long-term contextual memory in footshock-induced anxious rats. The results of this study demonstrated that the administration of eszopiclone and zolpidem both were equally effective in attenuating footshock stressor-induced suppression of slow-wave sleep (SWS). The administration of eszopiclone at 1 mg/kg or zolpidem at 1 and 3 mg/kg doses showed a tendency for attenuating stressor-induced suppression of REM sleep. However, the REM sleep attenuating effects of these drugs disappeared when they were administered at higher doses. The administration of eszopiclone at 3 and 10 mg/kg doses and zolpidem at all three doses reduced the power of electroencephalographic theta band frequencies during wakefulness. In addition, the administration of eszopiclone at 1 and 3 mg/kg doses suppressed stressor-induced anxiety-like behavior. The administration of zolpidem at 1, 3, or 10 mg/kg doses was not effective in attenuating stressor-induced anxiety-like behavior. Contextual memory after administration of eszopiclone at 1 mg/kg dose had no effects, but was reduced significantly with increased dosage. Contextual memory after administration of zolpidem, at all three doses, was severely disrupted. The results of this study suggest that eszopiclone at a low dose could be used effectively to control anxiety and anxiety-induced insomnia.

Web-based physician ratings are increasingly popular but imperfect proxies for clinical competence. Yet they provide valuable information to patients and providers when taken in proper context. Providers need to embrace the reviews and use them to enact positive change in order to improve the quality of our patients’ experience. Patients need to realize the limitations of online ratings, particularly with smaller sample size and be discerning about the reasons behind the review.